宫颈细胞学p16^(INK4a)蛋白检测联合细胞学检测在宫颈癌筛查中的价值  

Value of cervical cytological p16^(INK4a) protein detection combined with cytological test in screening cervical cancer

作　　者：刘湛秋 何玉[1] 许驰 胡晓文 王丽[1] 骆欣敏 LIU Zhan-qiu;HE Yu;XU Chi;HU Xiao-wen;WANG Li;LUO Xin-min(Department of Gynecology,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院妇科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2021年第4期479-483,共5页Journal of Bengbu Medical College

摘　　要：目的:探讨宫颈细胞学p16^(INK4a)蛋白联合细胞学检测在宫颈癌筛查中对宫颈癌前病变和宫颈癌的诊断价值。方法:选取790例20~70岁自愿行宫颈癌筛查的女性,同时行高危型人乳头瘤病毒(HR-HPV)、液基薄层细胞学检查(TCT)以及细胞学p16^(INK4a)蛋白检测。任一检测结果阳性以及检测均阴性但有明显临床症状高度怀疑宫颈病变者转诊阴道镜及活检,比较HPV、TCT及p16单独和两两联合筛查识别宫颈癌前病变及宫颈癌的检测效果。结果:所有筛查对象中,p16、TCT为不典型鳞状细胞以上(TCT≥ASCUS)和HR-HPV阳性率分别为14.6%、16.3%和25.6%。p16、HPV、TCT阳性率均随宫颈病变程度的加重呈趋势性增加(P<0.05~P<0.01)。p16+TCT、HPV+TCT、p16+HPV检测的灵敏度分别为92.1%、94.7%和97.4%,特异度分别为85.6%、77.5%和78.8%。HPV、TCT、p16、HPV+TCT、p16+HPV、p16+TCT诊断宫颈病变的曲线下面积分别为0.849、0.822、0.893、0.861、0.881、0.889,各指标对宫颈病变的诊断价值均有统计学意义(P<0.01)。结论:与HPV联合TCT检测相比,p16联合TCT检测对宫颈高级别病变及宫颈癌的筛查效果具有相似的敏感性和更高的特异性,可作为一种新型宫颈癌初筛方法。Objective:To explore the value of cervical cytological p16^(INK4a) protein assay combined with cytological assay in screening precancerous lesions of uterine cervix and cervical cancer.Methods:A total of 790 women aged 20 to 70 who volunteered to undergo cervical cancer screening were selected,and the high-risk human papillomavirus(HR-HPV),thinprep cytologic test(TCT)and p16^(INK4a) cytology detection in the subjects were implemented.The colposcopy and biopsy in patients with any positive test result or all negative test results complicated with obvious clinical symptoms with high suspicion of cervical lesions were examined.The detection effects of HPV,TCT and p16 alone,and combined screening for cervical precancerous lesions and cervical cancer were compared.Results:Among all screening subjects,the positive rates of p16,TCT diagnosed as ASCUS or higher grade and HR-HPV were 14.6%,16.3%and 25.6%,respectively.The positive rates of p16,HPV and TCT gradually increased with the increasing of cervical lesions severity(P<0.05 to P<0.01).The sensitivities of p16+TCT,HPV+TCT and p16+HPV detection were 92.1%,94.7%and 97.4%,respectively.The specificities of p16+TCT,HPV+TCT and p16+HPV detection were 85.6%,77.5%and 78.8%,respectively.The area under the curve of HPV,TCT,p16,HPV+TCT,p16+HPV,and p16+TCT in the diagnosis of cervical lesions were 0.849,0.822,0.893,0.861,0.881,0.889,respectively.The differences of the diagnostic value among each index to cervical lesions were statistically significant(P<0.01).Conclusions:Compared with the results of HPV plus TCT,the p16 plus TCT has similar sensitivity and higher specificity for screening cervical precancerous lesions and cervical cance,and can be used as a new screening method for cervical cancer.

关 键 词：宫颈肿瘤 宫颈上皮内瘤样病变 P16蛋白 液基薄层细胞学 人乳头瘤病毒 

分 类 号：R737.33[医药卫生—肿瘤]